Randstad Director of Specialty Bill Review in Tampa, Florida

Director of Specialty Bill Review


Tampa, FL


US$ 75,000 - US$ 90,000 per year

Date Posted:

Wednesday, September 28, 2016

Job Type:


Reference #:






Randstad USA Administration

DescriptionOur top client is seeking a Director, Specialty Bill Review professional based out of their Tampa, Fl office. This professional will be responsible for managing all functional areas of specialty review operations both internally as well as client & provider facing duties. The professional will have direct impact on virtually all areas of the company's operations; including core bill review functions, IT/ systems development, finance, and client support requirements. The professional will be relied upon to provide leadership and strategic direction for the company's position on a variety of regulatory interpretations, provider management policies, and client guidance regarding overall implant cost containment protocols and procedures. This is a great career opportunity for the right professional!


Manage the specialty implant review team in support of client implant cost containment programs that are currently in place and also manage resource and process planning in support of future client expansion:

Lead the development of all claims routing and review processes required to achieve efficient and effective program implementations

-Development of claims flow process

-Development of client-specific documentation per client requirements

* Assist with functional specifications and operational performance of our proprietary systems platform (FUSION)

*Assist with the coordination of workers' comp regulatory guidelines into Fusion application and within all review functions to ensure defensible outcomes.

*Develop reporting metrics as needed

Please email your resume to Shanese.Crosson@randstadusa.com for an immediate interview. Please list job description in the subject line. I look forward to hearing from you soon!

Working hours: Monday - Friday 8 AM - 5 PM



-Bachelors Degree or combination of education & equivalent work experience (Required)

-Previously worked in a Hospital or Surgery Center

-Working knowledge of workers' compensation regulatory framework - familiarity with state fees schedules and their application

-Fundamental knowledge of Medical Billing, Coding, and payment policies

-Strong organizational skills

-Experience/Knowledge of medical billing & and the relationship that exists between healthcare providers and the prayer community

-Workers' compensation market claims experience desired

-Surgery & Surgical implant procedural knowledge a plus

-Sound decision making abilities with a focus on attention to detail and quality awareness

-Computer literacy, including working knowledge to MS Office Suite

-General healthcare knowledge is (Required)

Software Knowledge:

Coventry Software Systems experience a plus

UB & HI knowledge experience a plus

- Great career opportunity

- Benefits packages offered

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad. EEO Employer: Race, Religion, Color, National Origin, Citizenship, Sex, Age, Disability, Ancestry, Veteran Status, Genetic Information, Service in the Uniformed Services or any other classification protected by law.